278 The Paediatric Major Trauma Tertiary Survey: Are We Missing the Mark on Missed Injuries?

Abstract

Abstract The tertiary survey is an integral part of assessment in major trauma. This has been shown to reduce missed injuries resulting in better patient care and favourable medico-legal outcomes. A formal tertiary survey should be carried out for all paediatric major trauma patients. The primary aim of this audit was to assess completion rates of the tertiary survey proforma for major trauma admissions under the paediatric surgery team at the Bristol Royal Hospital for Children. The secondary aim was to evaluate the adequacy of the current proforma and detect areas for improvement. Paediatric surgery major trauma admissions were audited over a 7-month period and data was collected retrospectively from patient notes on Evolve (n = 20). A formal tertiary survey was completed for 6 patients which equated to a completion rate of 30%. A total of 1 missed injury was identified (lip laceration) which required no further treatment. Head-to-toe examination was documented in all of the completed surveys but lacked detail. Documentation of gait was absent in 85% and a body map was not filled in for any of the patients. The audit was presented at a departmental meeting to increase awareness about the tertiary survey and requirements for completion. An MDT of doctors, nurses and trauma co-ordinators was consulted to design a more thorough proforma which included specific sections for review of bloods and imaging. Re-audit of the new proforma is ongoing and it is hoped that, in combination with educational initiatives, this will lead to increased identification of missed injuries.